Provider Demographics
NPI:1639512940
Name:HAN, YOUNG AE (DC)
Entity Type:Individual
Prefix:DR
First Name:YOUNG AE
Middle Name:
Last Name:HAN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1302 BARLASTON CIRCLE
Mailing Address - Street 2:SUITE 6
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062-8100
Mailing Address - Country:US
Mailing Address - Phone:404-392-7592
Mailing Address - Fax:678-547-3814
Practice Address - Street 1:3312 PEACHTREE INDUSTRIAL BLVD
Practice Address - Street 2:SUITE 6
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-8100
Practice Address - Country:US
Practice Address - Phone:404-392-7592
Practice Address - Fax:678-547-3814
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-17
Last Update Date:2013-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR006887111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor